Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Semin Nephrol. 2009 Nov;29(6):621-35. doi: 10.1016/j.semnephrol.2009.07.011.
There is an increase in the older incident end-stage renal disease population that is associated with an increasing prevalence of end-stage renal disease in the United States. This trend is paralleled by an increasing rate of kidney transplantation in the elderly. Although patient survival is lower in older versus younger kidney recipients, the elderly benefit from a reduction in mortality rate and improved quality of life with transplantation compared with dialysis. Immunologic, physiologic, and psychosocial factors influence transplant outcomes and should be recognized in the care of the elderly transplant patient. In this review, we discuss transplantation in the elderly patient, particularly the topics of access to transplantation, patient and graft survival, the impact of donor quality on transplant outcomes, immunology and immunosuppression of aging, and ethical considerations in the development of an equitable organ allocation scheme.
老年终末期肾病患者数量不断增加，这与美国终末期肾病的发病率不断上升有关。这一趋势与老年人群中肾脏移植率的上升相吻合。尽管与年轻的肾脏受者相比，老年受者的患者生存率较低，但与透析相比，移植可降低死亡率并提高生活质量，使老年受者受益。免疫、生理和心理社会因素影响移植结果，在老年移植患者的护理中应予以重视。在这篇综述中，我们讨论了老年患者的移植问题，特别是移植的准入、患者和移植物的存活率、供体质量对移植结果的影响、衰老的免疫学和免疫抑制以及公平器官分配方案制定中的伦理考虑等方面的问题。
